Medical ethics and physician motivations.

This paper provides an institutional economics framework for analyzing medical ethics. An ethical policy partitions the set of physician actions into (un)ethical subsets, with unethical actions then unavailable. Individual physicians' preferences over policies combined with a political process determine equilibrium constraints. I show that physicians' concern for colleagues' patients uniquely motivates their support for ethics which restrict behavior under strong assumptions. Without these assumptions, even identical physicians might ban actions they would otherwise select for reasons varying from protecting patients to differences in the costs of maintaining ethical policies. Interestingly, heightened altruism for colleagues' patients makes the former reasoning less credible. Novel applications for 'Provide Free Care to Physicians' and 'Duty to Treat in a Pandemic' demonstrate: (i) rising physician income can explain long-run weakening of both formal ethics in the United States; and (ii) the duty to treat can deteriorate as fewer physicians are required to improve pandemic outcomes.

Municipal solid waste management in Lagos State: Expansion diffusion of awareness.

This study examined the role of waste management authorities in promoting public awareness of municipal solid waste management (MSWM) through the lens of the expansion diffusion theory (EDT). EDT emphasizes the spread of new ideas and practices within a society through various communication channels and distinct individuals within each system. We employed a mixed-method approach using 116 survey responses from Lagos residents and five semi-structured in-depth interviews. Our findings reveal the need for a more structured approach to create public awareness of MSWM, considering the distinct groups of residents in Lagos and their responses to innovation and knowledge diffusion. We propose four pillars on which waste management authorities in developing countries can sustain their MSWM awareness campaigns, as well as an awareness campaign strategy flowchart. Our findings add to the expanding body of research on public awareness and participation in MSWM, emphasizing the critical role that waste management authorities can play in fostering sustainable waste management awareness and practices.

Local governance of the 2014 ebola Epidemic: a PhD synthesis.

BACKGROUND: The doctoral dissertation examines how local response efforts were integrated into overall emergency management. OBJECTIVES: It seeks to understand the role and effectiveness of community-based actors in addressing collective action problems. METHODS: Sixty-seven semi-structured interviews were conducted from January to July 2017 in Liberia and Sierra Leone. Key informants include healthcare workers, traditional leaders, and community stakeholders, such as non-governmental organization representatives and volunteers. RESULTS: Findings show that traditional and community leaders responded to the public health emergency via rulemaking, quarantine, travel limitation, healthcare referrals, health sensitization, and door-to-door contact tracing. These actions by local leaders helped to change behaviors and improve cooperation. Sierra Leone had 32.3% more Ebola cases than Liberia but 18% fewer deaths. Sierra Leone had integrated traditional and community leaders before the scale up of international aid resources. CONCLUSION: This suggests that actions taken by traditional and community leaders improved overall efforts, and in some areas, before scaled-up humanitarian interventions. Bilateral engagement with local community actors should be integrated in every public health response to improve cooperation, and it should be done before an intervention is conceived and executed.

Main findings: Bottom-up legislation and community-led action were significant in containing the EVD spread in Liberia and Sierra Leone.Contribution to knowledge: Theoretical contribution centers on the governance patterns of Traditional Local Institutions. Evidence-based contribution was the observation of polycentric governance patterns of demand and supply-side barriers between traditional, state, and aid institutions.Global health impact for policy and action: Policymakers should contextualize soft factors such as trust, which can hamper technical advice. Any intervention should include bilateral engagement with local community leaders.

Assessing the spatial equity of the aged care institutions based on the improved potential model: a case study in Shanghai, China.

With the spread of an aging society, the demand for aged care institutions among older adults is increasing. The inadequate supply and distribution of aged care institutions have led to an increasing concern about spatial equity in aged care institutions. Most studies have utilized accessibility to assess spatial equity from the supply perspective, while the demand perspective has received little attention. In addition, few studies have evaluated the spatial equity of aged care institutions at grid resolution. Therefore, this study takes Shanghai as an example to analyze aged care institutions from both the supply and demand perspectives. By proposing an improved potential model, at a network resolution of 500 × 500, the spatial equity of aged care institutions is more refined. The results show that aged care institutions and the older population in Shanghai are predominantly concentrated in the downtown area and surrounding regions. However, the results obtained from the Lorenz curve and Gini coefficient indicate the allocation of pension beds based on population size is proportional across different districts of Shanghai. When considering the quality indicators of aged care institutions and introducing the improved potential energy model to calculate spatial accessibility, an imbalance between regions in Shanghai still exists and needs further optimization.

Institutional care and education: circulation of knowledge about epilepsy in Sweden 1915-40.

This article focuses on the circulation of knowledge about epilepsy in Sweden between 1915 and 1940. During the period medical research on epilepsy increased, which simultaneously brought a new degree of specialisation and distinction between branches of medicine. The aim of this article is to study the impact of new medical knowledge about epilepsy on the treatment and education of children with epilepsy in Sweden. In order to concretise the aim, the study focuses on the asylum Margarethahemmet. The key source material consists of Margarethahemmet's annual reports and yearbooks. The minutes of the meetings of the Swedish General Association for the Care of the Feebleminded and Epileptic for the period 1915-1938 have been used as supplementary material. In order to trace the impact of medical discoveries on Margarethahemmet's operations, contemporary scientific articles, mostly from Germany, have also been used. The article demonstrates how new research and new knowledge was sought internationally and nationally, to provide doctors and special teachers at the asylum with a proper knowledge about education, care and treatment for children with epilepsy. The increased understanding of the disease directly impacted the ability of a stigmatized group - people with epileptic disorder - to actively participate in society on the same terms as others.

Unravelling the nexus of microfinance and women's non-communicable disease (NCD) health outcomes in Sri Lanka: An exploratory study.

ABSTRACTNon-communicable diseases (NCDs) are a major contributor to the global burden of disease, increasingly impacting low-income and marginalised populations in low- and middle-income countries such as Sri Lanka. Microfinance could be a potential approach to target NCDs. Using an ethnographic approach with thematic analysis, this study explored the nexus between microfinance and NCD outcomes. In-depth interviews were conducted with 29 micro-loan borrowing women across 15 field sites within Puttalam district in Sri Lanka. The findings revealed that perceived increases in income from microfinance loans contributed to enhanced household health savings ability, enabling the purchase of medicines bought out-of-pocket and from privately owned pharmacies, and spending for NCD-relevant health emergencies and health-related transportation. Additionally, perceived income increases also influenced the behavioural risks, including the spending and consumption of food, and physical activity levels, both positively and negatively. The microfinance networks also influenced women's perceived social support, psychological stress and coping mechanisms, and health information transmission, positively and negatively. The findings from this study provide important insights on how financial inclusion programs such as microfinance influence the health determinants and outcomes relevant to NCDs. This can help address ways to target both NCDs and inequities of socioeconomically disadvantaged and marginalised populations, particularly women.

Scoping review on mental health standards for Black youth: identifying gaps and promoting equity in community, primary care, and educational settings.

BACKGROUND: Youth mental health is a growing concern in research, practice, and policy. Practice standards, guidelines, or strategies provide an invisible infrastructure that fosters equity, quality, and safety, potentially addressing inconsistencies and more effectively attending to the mental wellness of Black youth as a particular population of concern. This scoping review aimed to address the following question: What standards exist for the delivery of mental health services to Black youth in community, primary care, and educational settings? Due to a limited initial search yield on publications about standards for the delivery of mental health services for Black youth population, our goal was then to identify and map mental health standards, recommendations, or guidelines for the delivery of mental health services using the same settings to all youth. METHODS: Searches were conducted in various databases, including PubMed/MEDLINE, PsycINFO, Embase, SocINDEX, CINAHL, Gender Studies Database, Social Services Abstracts, Sociological Abstracts, Scopus, Web of Science, and Google Scholar. Screening was independently conducted by two reviewers, with disagreements resolved by a third. Information extraction was performed by two independent reviewers. RESULTS: Out of the 2,701 screened publications, 54 were included in this scoping review. Among them, 38.9% were published between 2020 and 2023, with 40.7% originating from the United States of America, 20.4% from the United Kingdom, and 13% from Canada. Concerning the settings, 25.9% of the publications focused on primary care, 24.1% on health care services, 20.4% on educational settings, and 3.7% on the community. Additionally, 25.9% were classified as general because recommendations were applicable to various settings. Attention-deficit/hyperactivity disorder (11.1%) was the most frequently considered specific condition, followed by autism spectrum disorder (9.3%) and depression (9.3%). However, 31.5% of the included references addressed mental health in general. Only three references provided specific recommendations for the Black population. CONCLUSIONS: Recommendations, guidelines, or standards for Black youth mental health services in community, primary care, or educational settings are scarce and limited to North American countries. This scoping review emphasizes the need to consider ethnicity when developing guidelines or standards to improve racial equity and reduce disparities in access to mental health services.

Can health promotion facilitate development in fragile states?: An instrumental variable estimation with panel data.

Despite the potential role of health being recognised for more than a decade in fragile contexts, there are still gaps in understanding the possible paths towards peace. Particularly, current literature on health and development presents limitations, including insufficient evidence, a lack of thorough consideration for fragility and tensions between humanitarian and developmental approaches. Building upon prior discussions and limitations, this study aims to investigate the association between health indicators and the levels of economic and human development, employing panel data of 60 fragile states covering the years 1995-2021. Seven health outcome measures and three proxy measures for economic and human developments, including GDP per capita and Human Development Index with and without inequality adjustment, are employed in instrumental variable estimation. The analysis shows a positive association between the development measures and corresponding health indicators. These results suggest that promoting the health of the people, particularly among marginalised groups such as pregnant women and children, not only has the potential to protect them but also to facilitate economic and human developments of the fragile states. There is a need for approaching with people-centred and human capability perspectives to achieve the goal of 'Health and Peace for All'.

Radiography managers' perceptions on skills required in public health institutes in Gauteng.

Background: Management of radiography departments requires skilled and competent managers. This task becomes complex if there is no management development and collaborative performance monitoring. Aim: The study aimed to explore and describe the radiography managers' perceptions regarding management training and skills required. Setting: The research was conducted in public health institutions of Gauteng, South Africa. Methods: Qualitative, exploratory and descriptive approach was adopted, and a purposive sampling method was used to select twenty-three (23) managers from the radiography departments; however, data saturation guided the sample size. Data were collected through online focus group discussions (FGDs). Ethical approval was obtained through Departmental Research Committee (DRC) of Medical Imaging and Radiation Sciences (MIRS) department, Higher Degrees Committee (HDC), Research Ethics Committee and Gauteng Department of Health Research Committees. Data trustworthiness was obtained through member checking, data verification and an independent coder to verify the accuracy of the data. Thematic data analysis method was used to analyse the data. Results: Five themes emerged from the thematic analysis and centred on: difficulties in transitioning into management, lack of management support, the need for postgraduate management qualification, coaching and mentoring and required skills for radiography managers. Conclusion: Public health institutions continuously face transitions in service delivery frameworks. This requires competent and skilled radiography managers to survive in this environment. The study revealed that new managers experience difficulties and require management support to succeed in their roles. Contribution: Awareness of managers developmental needs relative to the real-life dynamics of radiography management in Gauteng public health environment.

Process of Renewal of PC&PNDT License of a Large Tertiary Care Teaching Hospital of North India: How One Needs to Plan for It?

Background The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act (PC&PNDT Act), 1994 was enacted to prevent sex determination and female feticide. As a mandatory statutory requirement, All India Institute of Medical Sciences, New Delhi, India has to renew its PC&PNDT license after every 5 years. Aim The current study was undertaken with an objective to delineate in detail, the process of PC&PNDT license renewal, and the challenges dealt with while submitting the renewal application. Methods and Material An observational descriptive study was conducted from February to July 2022. The renewal process was categorized into preapplication, application, and postapplication phases. The requisite documents and data were collected from the Hospital Establishment Section and Medical Records Department. Results The preapplication phase involved obtaining details from 24 departments, with 20 responding initially. Challenges included incomplete documents and deficient details. The application phase required consolidation, affidavits, form filling, and fee payment. Postapplication, an inspection was conducted, and the renewal certification was obtained. Conclusion The study highlights the complexities of renewal of PC&PNDT license of a large multispecialty tertiary care teaching hospital. Planning leads obtained during various phases could serve as a guiding template for other similar teaching hospitals. The study suggests the need for digitalization and streamlining of documentation process to ease out the renewal process and hence contribute to better patient care at large.

The impact of financial decentralization and investments in green power on the ecology in the European union: How does the governance of institutions moderate this relationship?

There has been a growing emphasis in recent scholarship on the environmentalist movement, necessitating robust data to substantiate claims regarding the impacts of financial decentralization and investments in green power on the ecology. This study investigates the multifaceted impact of these factors within a subset of EU member states from 2000 to 2020, with a particular focus on their implications for environmental sustainability. Employing an advanced-panel method, the investigation utilizes enhanced self-regressive distribution delays (CS-ARDL) to analyze the cumulative and immediate connections between financial decentralization, green power investments, and environmental outcomes. The study reveals that effective governance of institutions plays a crucial role in moderating this relationship, influencing the extent to which financial decentralization and green energy investments contribute to environmental preservation. Preliminary findings indicate that regions with decentralized financial systems and substantial investments in green power exhibit reduced carbon dioxide emissions and improved environmental quality. This positive impact is further amplified by sound institutional oversight, ensuring that investments in clean energy align with ecological sustainability goals.The study also underscores the importance of a coordinated approach, where financial decentralization, investments in green power, and institutional governance synergistically contribute to environmental resilience and sustainable development. These efforts not only mitigate environmental challenges but also stimulate economic growth, job creation, and technological innovation in the renewable energy sector. The impact of financial decentralization and investments in green power on environmental sustainability in the European Union is significant, with governance playing a pivotal role in shaping positive outcomes. This study provides valuable insights for policymakers and stakeholders seeking to promote a greener and more sustainable future within the EU.

Epidemiology of COVID-19 in Berlin-Neukölln nursing homes.

BACKGROUND: The COVID-19 pandemic has affected various urban population groups in different ways. Earlier studies have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disproportionally impacts nursing home residents by increasing morbidity and mortality following viral exposure. However, little is known about the epidemiology of this disease in detail. Therefore, the objective of this study is to analyze the development of the COVID-19 pandemic in 14 nursing homes across Berlin-Neukölln, Germany, during pandemic waves 1 to 5 (Feb 2020 - May 2022). METHODS: Reporting data to the Neukölln Department of Public Health on COVID-19 cases in connection with nursing homes were extracted from the SORMAS database. The case fatality rates (CFRs) and odds ratios (ORs) of demographic parameters, prevalent variants of concern (VOCs) and vaccine availability were calculated. In addition, the temporal course in waves 1-5 in Neukölln and the relevant government measures were examined. RESULTS: Data collected from nursing homes providing age-dependent physical care revealed that 1.9 % of the total 108,600 cases registered in Berlin-Neukölln during the study period were related one of the 14 facilities. Compared to the general population in Neukölln, nursing homes exhibited a 20-fold increase in the CFR. Notably, nursing homes with higher bed capacities displayed a greater CFR than did smaller nursing homes. Similarly, elderly residents living in nursing homes faced a much greater mortality rate than did their counterparts living outside of medical settings (OR = 3.5). The original wild-type SARS-CoV-2 strain had the most severe direct impact, with a CFR of 16.7 %, compared to the alpha (CFR = 6.9 %), delta (CFR = 10.2 %) and omicron (CFR = 2.8 %) variants in nursing homes. Interestingly, the number of infections increased following vaccination campaigns, but this trend was accompanied by a decrease in the number of deaths from 2.6 to 1.1 per week. As a result, the CFR significantly decreased from 18.4 to 5.5, while still exceeding the mean CFR compared to that of the general population of Neukölln. CONCLUSIONS: Our findings reveal the changing patterns of outbreak frequency and severity across the five pandemic waves. They highlight the crucial role of rapid vaccination programs for residents, staff, visitors, and third-party services in safeguarding nursing homes. Additionally, improvements in containment and cluster strategies are essential in prevaccination scenarios to prevent future infection traps for elderly individuals in long-term care facilities. The presented data highlight the importance of tailored protection measures for one of the most vulnerable populations in our society.

Do institutions evolve like material technologies?

Norms and institutions enable large-scale human cooperation by creating shared expectations and changing individuals' incentives via monitoring or sanctioning. Like material technologies, these social technologies satisfy instrumental ends and solve difficult problems. However, the similarities and differences between the evolution of material technologies and the evolution of social technologies remain unresolved. Here, we review evidence suggesting that, compared to the evolution of material technologies, institutional and normative evolution exhibits constraints in the production of variation and the selection of useful variants. These constraints stem from the frequency-dependent nature of social technologies and limit the pace and scope of normative and institutional evolution. We conclude by reviewing research on the social transmission of institutions and norms and highlighting an experimental paradigm to study their cultural evolution.

Characteristic features of late-onset systemic lupus erythematosus: An observational study of data from the Lupus Registry of Nationwide Institutions.

OBJECTIVE: Late-onset systemic lupus erythematosus (LoSLE) is known to possess characteristics different from those of early-onset SLE (EoSLE), thereby making their diagnosis difficult. This study aimed to assess the characteristic features of LoSLE in Japan, a model country with a super-aged society. METHODS: Data were obtained from the Lupus Registry of Nationwide Institutions, which includes a multicenter cohort of patients with SLE in Japan who satisfied the 1997 American College of Rheumatology revised classification criteria for SLE. Data were compared between patients with LoSLE (≥50 years old at onset) and EoSLE (<50 years old at onset). To identify factors associated with LoSLE, binary logistic regression was used for the multivariate analysis, and missing values were complemented by multiple imputations. We also conducted a sub-analysis for patients diagnosed within 5 years of onset. RESULTS: Out of 929 enrolled patients, 34 were excluded owing to a lack of data regarding onset age. Among the 895 remaining patients, 100 had LoSLE, whereas 795 had EoSLE. The male-to-female ratio was significantly higher in the LoSLE group than in the EoSLE group (0.32 vs 0.11, p < 0.001). With respect to SLEDAI components at onset, patients with LoSLE exhibited a higher frequency of myositis (11.9% vs 3.75%, p = 0.031), lower frequency of skin rash (33.3% vs 67.7%, p < 0.001), and lower frequency of alopecia (7.32% vs 24.7%, p = 0.012). No significant differences in overall disease activity at onset were observed between the two groups. Regarding medical history, immunosuppressants were more commonly used in EoSLE. A multivariate analysis revealed that a higher male proportion and a lower proportion of new rash at onset were independent characteristic features of LoSLE. We also identified late onset as an independent risk factor for a high SDI score at enrollment and replicated the result in a sub-analysis for the population with a shorter time since onset. CONCLUSIONS: We clarified that LoSLE was characterized by a higher male proportion, a lower frequency of skin rash and a tendency to organ damage. Now that the world is faced with aging, our results may be helpful at diagnosis of LoSLE.